阻塞性睡眠呼吸暂停低通气综合征合并高血压与微觉醒及低氧血症的相关性

Arousal and hypoxia in patients with obstructive sleep apnea-hypopnean syndrome combined with hypertension

目的探讨微觉醒和低氧血症与阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者发生高血压的相关性及两者在发病机制中的地位。方法测定63例OSAHS、70例OSAHS合并高血压患者的清晨血压、睡眠构成比、微觉醒指数、呼吸暂停低通气指数(AHI)、血氧饱和度低于90%的时间(SLT90%)及氧减饱和度指数。并将OSAHS合并高血压患者的血压分别与年龄、性别、体块指数(BMI)、AHI、微觉醒指数、SLT90%、清醒时间、快动眼睡眠时间、1期睡眠时间、2期睡眠时间、深睡眠期时间(3+4期)和氧减饱和度指数作多元线性回归分析。结果OSAHS合并高血压患者的SLT90%、氧减饱和度指数、微觉醒指数较OSAHS患者显著增加(均P<0.05)。导致OSAHS患者合并高血压的第一重要因素为微觉醒指数(SBP:r=0.54,P<0.01;DBP:r=0.42,P<0.05),第二重要因素为SLT90%(SBP:r=0.45,P<0.05;DBP:r=0.35,P<0.05)。结论OSAHS患者存在着明显的睡眠结构紊乱,合并发生高血压时,发病机制中首要的是微觉醒,其次是低氧血症。

Objective To investigate the correlation of hypertension with hypoxia and arousal in patients with obstructive sleep apnea-hypopnean syndrome （OSAHS）. Methods The study included 133 OSAHS patients with or without hypertension. Morning blood pressure, arousal index, time length of nocturnal oxygen saturation 〈90%（SLT90%） were measured in these patients. Multiple stepwise regression analysis was performed to find the correlation between morning blood pressure and arousal index, SLT90%, AHI, age, body mass index （BMI）. Results Arousal was primary independent factor leading to hypertension in OSAHS patients（SBP：r=0.54, P〈0.01;DBP：r=0.42,P〈0.05） and SLT90% was secondary independent factor（SBP：r=0.45,P〈0.05;DBP：r=0.35,P〈 0.05）. Conclusion Disorder of sleep architecture and hypoxia are the most important mechanism in OSAHS patients with hypertension.